Healthcare Provider Details

I. General information

NPI: 1467421099
Provider Name (Legal Business Name): DIANE HELENE FREEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY STE 200
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

500 S UNIVERSITY STE 200
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4117
  • Fax: 501-664-1137
Mailing address:
  • Phone: 501-664-4117
  • Fax: 501-664-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE28649
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: